Provider Demographics
NPI:1629678644
Name:MCNAMARA, TABITHA (MSN ED,BSN,RN)
Entity Type:Individual
Prefix:PROF
First Name:TABITHA
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:MSN ED,BSN,RN
Other - Prefix:PROF
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:GARBUTT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:114 BRANDYWINE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-1402
Mailing Address - Country:US
Mailing Address - Phone:716-390-1146
Mailing Address - Fax:716-453-1506
Practice Address - Street 1:114 BRANDYWINE DR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-1402
Practice Address - Country:US
Practice Address - Phone:716-390-1146
Practice Address - Fax:716-453-1506
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY530874163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse